AI POWERED CLAIMS EXTRACTION Qbotica

Challenge	Solution
The medical enrollment process is highly complex, involving several versions of enrollment forms, each tailored to different types of healthcare providers and suppliers. Maintaining accurate enrollment information in the Medicare program is crucial, especially with strict compliance to Medicare rules and regulations. One key challenge involved processing and managing the CMS-855 form, essential for ensuring compliance. Given the volume and complexity of the data, traditional manual methods were time-consuming and prone to errors, impacting both employee productivity and the overall customer experience	To address these challenges, Elevance Health implemented an AI-driven solution focused on unstructured claims data extraction from electronic medical records (EMR) systems. This solution leveraged Optical Character Recognition (OCR) and AI technologies to accelerate the claims processing workflow. Key features of the solution included: Document Understanding The system was designed to interpret and classify complex medical documents accurately. Action Center with Human-in-the-Loop While the AI handled the bulk of the processing, human oversight ensured that exceptions and complex cases were handled with the necessary attention to detail.

Challenge

Solution

The medical enrollment process is highly complex, involving several versions of enrollment forms, each tailored to different types of healthcare providers and suppliers. Maintaining accurate enrollment information in the Medicare program is crucial, especially with strict compliance to Medicare rules and regulations.

One key challenge involved processing and managing the CMS-855 form, essential for ensuring compliance.

Given the volume and complexity of the data, traditional manual methods were time-consuming and prone to errors, impacting both employee productivity and the overall customer experience

To address these challenges, Elevance Health implemented an AI-driven solution focused on unstructured claims data extraction from electronic medical records (EMR) systems. This solution leveraged Optical Character Recognition (OCR) and AI technologies to accelerate the claims processing workflow.

Key features of the solution included:

Document Understanding The system was designed to interpret and classify complex medical documents accurately.

Action Center with Human-in-the-Loop While the AI handled the bulk of the processing, human oversight ensured that exceptions and complex cases were handled with the necessary attention to detail.

Key Benefits And Results

CLIENT OVERVIEW

Elevance Health is a Fortune 100 organization offering health plans and clinical, behavioral, pharmacy, and complex-care solutions that promote whole health. They manage a diverse range of healthcare providers and suppliers who need to enroll in Medicare or update their enrollment information

RESULTS

The implementation of this AI-powered solution led to significant

Improvements in several key areas:

Increased Productivity Employees could focus on more critical tasks, as the AI took over the repetitive and time-consuming aspects of the enrollment process.

Improved Customer Experience Faster processing times and more accurate data handling led to a more seamless experience for healthcare providers and suppliers.

Higher Data Accuracy The reduction in manual errors led to more accurate enrollment records, ensuring compliance with Medicare regulations.

Increased Operational Efficiency Overall, the process became more streamlined, reducing the time and resources required for handling enrollment and claims processing